THE VILLAGE BICYCLE CLUB MEMBERSHIP APPLICATION

 

Name____________________________________________________

 

Address__________________________________________________

 

City _____________________ State __________ Zip _____________

 

Village I.D. Number_________________________________________

 

Phone __________________________ 

 

E-mail ___________________________________You may Publish!      Yes ____  No _____

 

MEMBERSHIP: Family or Significant Other - $ 7.00 Fee _________
Family/Significant Other Member _____________________________________________________ 

 

Check Payable to: The Village Bicycle Club    New Member? ________ Renewal?   _____________ Check: _____   Cash: _____

 

WAIVER:  I, the undersigned, do hereby waive and disclaim, for myself, my heirs and assigns, any and all claims for any personal injuries and/or property damages which may arise pursuant to any The Village Bicycle Club (TVBC) activity, against TVBC or any members thereof, whether connected with an event, as an active participant, or in a governing or planning capacity, and I further agree to indemnify and hold harmless the said, THE VILLAGE BICYCLE CLUB, INC., on account of my activities or those of my family in said Club.  I have read the above statement in it entirety and do hereby attest.

Signature_________________________________________________

Printed Name  _____________________________________________ 

Date ______________________

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

NOTE: 

            Our membership year starts in January and the annual dues are $7.00. This includes the rider and the significant other.  

            To join "The Village Bicycle Club", you must be a resident of The Villages, Florida.  

            Please print the application and mail it with a check, in the amount of $7.00, made out to "The Village Bicycle Club" to the membership/offcr.

            The Address can be found under a listing of our officers.  Upon receiving the application and verifying the residence requirement,   

            your application will be processed.  

            If you are a temporary resident and have a Village identification number, you are eligible to join the club.  

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Membership Director Only

 

CHECK #______________ ENTERED_________________